Migraines

What is a migraine?

There are certain headache symptoms that a person must have for a headache to be diagnosed as a migraine. A doctor or health care provider decides what type(s) of headache a child is having.

Migraines have some or all of the following features:

Headache pain that is moderate to severe.

Headache episodes that last 4 to 72 hours. In younger children, it is thought that migraine may be shorter and last 1 to 72 hours.

Pain that is one-sided (unilateral) or on both sides of the head (bilateral).

Pain that is pulsating, pounding or throbbing.

Pain that is worse with physical activity.

Sensitivity to light and sounds.

Nausea that may or may not lead to vomiting.

To be diagnosed with migraines, a child needs to have at least five headaches that meet these criteria. Some children’s headaches that almost fit the criteria do not (yet). We often diagnose ‘probable’ migraine in these children.

Some children have migraine headache with an aura. An aura is a warning symptom that happens before the headache begins. An aura may last 5 to 60 minutes. A visual aura is one that the person sees. It can involve colored or flashing lights, wavy lines, blind spots or blurry vision. Other auras can be described as an odd feeling, or tingling in the face, arm or leg. A few people with migraine may have muscle weakness, a loss of coordination, stumbling or trouble speaking. Your healthcare provider needs to know if your child or anyone else in the family has migraines that cause muscle weakness.

Do migraines run in families?

Migraines can run in families. Most people who have them probably have other family members with migraine, but it may be hard to know the complete family history.

Less than half of all people with migraines have been diagnosed by a healthcare provider because:

Symptoms of different types of headaches can be very similar.

Family members may have been diagnosed with sinus headache or tension-type headache when they actually have migraine.

A family member with severe headaches may think he has migraines. The headaches actually might not meet criteria.

Are there variations of migraine?

Many specialists feel that certain forms of belly pain and vomiting that recur are a kind of migraine. For some children, the headache part of a migraine is missing. Sometimes these problems can be treated with the same medicines that are used to treat typical migraines.

Abdominal Migraine or Cyclic Vomiting

Abdominal migraines consist of belly pain, nausea, vomiting and possibly diarrhea. They happen again and again over time.

Cyclic vomiting in children can happen with frequent vomiting, up to 10 times an hour. In between the episodes, the child usually seems healthy without any stomach complaints. Over time, the symptoms return regularly and in a pattern.

Medical tests should be done to check for other gastrointestinal (GI) problems. If these tests are normal, abdominal migraine or cyclic vomiting may be diagnosed.

Medicines that prevent or treat headaches may help with these conditions. Many children with abdominal migraine or cyclic vomiting develop migraine headaches as they grow older.

Benign Paroxysmal Vertigo of Childhood

Benign Paroxysmal Vertigo of childhood happens in children, often between 2 and 6 years of age. Symptoms start all of a sudden. They include difficulty with balance, feeling dizzy or feeling like the room is spinning (vertigo). This only lasts a few minutes. It resolves on its own in otherwise healthy children.

Hemiplegic Migraine

This migraine causes weakness of the arm or leg that you can see on one side of the body. Usually the weakness comes before the head pain begins, but it may also become noticeable during the headache. This is a true loss of muscle power that clearly reduces movements on only one side of the body. The weakness usually passes within 24 hours. There may also be drooping of the face or eye and garbled speech. The child should be brought to the emergency room the first time this happens to see if anything more serious is happening.

What is a tension-type headache?

Tension headache is the most common headache type in children. Tension headaches are often mild headaches that stop with medicine and rest. This type of headache has also been called a muscle-contraction headache, stress-related headache and “ordinary headache.”

There are certain symptoms that are necessary for diagnosis of a tension-type headache. It is best for a doctor or practitioner to decide what type(s) of headache a child is having.

Tension-type headaches usually have these features:

Pain is mild or moderate.

Headache lasts 30 minutes to 7 days.

Pain tends to be on both sides of the head (bilateral). It may be all over the head, or band-like around the head. There may be neck pain or shoulder pain as well.

Pain is pressing, tight, aching, sore or dull.

Usually pain is not made worse with physical activity.

There is sensitivity to light or sounds, but usually not both.

Nausea or vomiting does not usually happen. Pain may begin gradually.

What does it mean to have episodic headaches or chronic headaches?

Headaches are considered episodic if:

They happen fewer than 15 days each month and head pain resolves between episodes.

Headaches are considered chronic if:

They happen 15 or more days per month.

They continue this often for 3 months or more.

If headaches meet these criteria, the patient is diagnosed with Chronic Daily Headache (CDH). This may be either Chronic Tension Type Headache or Chronic Migraine. Often there is a combination of headache types. Other types of chronic headaches include Medication Overuse Headache (MOH) and New Daily Persistent Headache (NDPH).

What is a New Daily Persistent Headache (NDPH)?

This is a chronic headache that becomes daily within 3 days. Patients often remember the exact date and time that the headache began. The headache then continues, usually without real breaks in pain, for more than 3 months. The way the headache feels can change during the day and during the month. An MRI (imaging of the brain) is often recommended for patients with NDPH due to the sudden start to the headache, and the way it continues without relief. These headaches are very unusual. Sometimes they begin after a stressor, minor illness, head injury or surgery. Sometimes the headache can continue for a long time.

What is a Medication Overuse Headache?

Medication Overuse Headache (MOH) is a kind of chronic daily headache. It is caused by taking too many or too much pain medicine. MOH is also called rebound headache, drug-induced headache and medicine-misuse headache.

Using pain medicine too often can actually lead to more headaches. MOH is likely if your child’s headaches are getting worse and the child has been taking pain medicines most days over a period of 2 months or longer. Overuse is possible even with simple over-the-counter pain medicines such as Tylenol (acetaminophen), Motrin, Advil (ibuprofen) and Aleve (naproxen). Using migraine medicines such as Imitrex (or other Triptans) too often can also cause Medicine Overuse Headache.

Medication Overuse Headache can be a hard diagnosis. We know that families want the headaches to go away. The first instinct is to take pain medicine for each headache. Unfortunately, most medicines designed to treat pain right away can add to the rebound effect.

Your provider will tell you to stop taking all pain medicines for at least several weeks. This is to break the cycle of rebound headaches. Stopping the pain medicines may make headache symptoms worse for a short time. However, after that short time, headaches usually start to improve.

When pain medicines are taken too often, a chronic form of rebound can occur in some people. This chronic rebound causes a daily headache. Not everybody gets a daily headache when pain medicines are overused. We do not know why some people develop this response and others do not. Unfortunately there are no quick fixes for this type of headache. Stopping the overused medicine is necessary and, in most patients, effective. Do not replace one form of pain medicine with another. Gradually, as the body recovers, headache frequency will often improve. Your child’s provider may prescribe a daily medicine that can help with this process.